When to Worry, When to Wait: Advice from a Speech-Language Pathologist

As a speech pathologist and mom of two, I get asked a lot of questions about children’s communication milestones. Here are some of the most common questions parents ask and how I typically answer them.

When should my child start talking?

Most parents know that babies are born communicating. There’s a reason many caregivers say they can tell the difference between their baby’s cries: some mean hunger, others mean it’s nap time. It’s amazing to watch early communication unfold between a baby and caregiver.

All babies develop at their own pace, but in general, babies begin to babble around 6 months. That babbling becomes more complex as babies grow, with new sound variations and intonation patterns emerging all the time. By around 12 months, you’ll likely hear babbling mixed with some “true” words. Around this age, children are also understanding many familiar words, pointing to pictures in books, and identifying simple vocabulary such as body parts.

A child’s first birthday comes with lots of milestones. Many (though not all) children are starting to walk, and their first “real” words often appear around this time too. By one year, most children have at least 3 true words they use consistently. Their vocabulary then takes off, and by 18 months, children typically use 10–50 words and begin combining them into simple two-word phrases.

My two-year-old isn’t talking much. Should I be concerned?

When parents ask this, I usually respond with a few questions of my own, because “not talking” can mean different things. Often, the child does have some words, but parents may not realize what “counts” as a word.

For example, animal sounds like “moo” or “woof woof” count as words, as do social phrases like “uh-oh!” or “bye-bye.” Word approximations count as well.  So if your child is saying “duh,” while pointing at a picture of a duck in a book, that’s a word!  In general, by age two children should be saying around 50 words (or word approximations) and should be beginning to combine them into two-word phrases, such as “Mommy walk,” or “Baby cry.” 

At this age and stage, it’s also important to distinguish between repeated and spontaneous speech. Most two-year-olds repeat a lot, and that’s wonderful! But we also want to hear them spontaneously generating their own words to communicate a variety of needs (e.g., making requests, answering simple questions, making social comments, labeling) and beginning to put them together into short phrases.

All of a sudden my child seems to be stuttering. Does he need speech therapy?

Between the ages of 2 and 4, children experience what many speech therapists call a “language explosion.” They’re learning tons of new words, figuring out grammar, and navigating the social rules of communication. It’s not uncommon for their mouths to struggle to keep up with their brains during this time, sometimes resulting in repetitions that sound like stutters.

If your preschooler is repeating words or prolonging sounds, it’s often a normal developmental phase.  When possible, make an effort to model slow, smooth speech for your child when you talk.  It’s also okay to point out that you noticed a “bump,” in your child’s speech.  For example, You could say: “I just heard a bump in your speech! Did you hear it too? Want to try it again smoother?”

Follow your child’s lead with this suggestion.  If they seem embarrassed, don’t push it.  Most kids who go through phases of stuttering truly don’t notice it in their own speech so raising their awareness can be helpful, as long as it’s done in a playful way.  Some families find “turtle talk,” a slow and smooth speaking game, helps make speech practice fun.

If the stuttering lasts more than six months, or there’s a family history of stuttering, talk with your pediatrician or seek an evaluation from a speech-language pathologist who specializes in fluency disorders.

I understand my child but other people don’t. Should she be in speech therapy?

It’s very common for parents to act as interpreters for their toddlers. However, by age 4, most children should be understood by unfamiliar listeners most of the time.

Some later-developing sounds (like “r” or “s-blends”) can be tricky until around age 6, but overall by age four children should be able to communicate their messages without a lot of need for interpretation. If your four-year-old is only understood about half the time by strangers, a speech and language evaluation may be helpful. Early support prevents speech patterns from becoming ingrained and helps children gain confidence communicating with others.

It sounds like my child may need some intervention. Where do I start?

You can begin by talking with your child’s pediatrician for a referral or list of local speech therapy resources.

• If your child is under 3 years old, you can reach out directly to Help Me Grow, Ohio’s Early Intervention (EI) program. If you live outside of Ohio, check similar resources available in your state. They offer free developmental screenings and services for eligible children. You can learn more or make a referral at www.helpmegrow.ohio.gov or by calling 1-800-755-GROW (4769).

• For children ages 3 and older, contact your local school district to request a free speech and language evaluation through their preschool or special education department.

• Families can also explore private speech therapy options for individualized services that may be available in homes, clinics, or community settings.
  

Early identification and support can make a big difference.  If you have concerns, trust your instincts and seek guidance. You know your child best.